Early surgical stabilization reduces perioperative complications in older adults with thoracolumbar fractures from high-energy trauma: a propensity score-matched analysis.

Abstract

Thoracolumbar fractures from high-energy trauma in older adults often occur in the setting of frailty and comorbidities, yet evidence on the benefits of early surgery in this group remains limited. This study aimed to evaluate whether early surgical stabilization reduces perioperative complications in older patients with thoracolumbar fractures caused by high-energy trauma. We conducted a retrospective cohort study of 110 patients aged ≥ 65 years who underwent surgery for traumatic thoracolumbar fractures from high-energy trauma between 2015 and 2025. Patients were grouped into early surgery (≤ 72 h) and delayed surgery (> 72 h). Baseline differences were adjusted using one-to-one propensity score matching based on background factors and severity of associated injuries. A receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff for predicting complications. Of the 110 patients, 45 underwent early and 65 delayed surgery. Before matching, the early group had significantly fewer perioperative complications (31.1% vs. 67.7%, p = 0.001), particularly pneumonia (6.7% vs. 30.8%, p = 0.002). After matching (33 pairs), early surgery remained associated with lower complication rates (27.3% vs. 60.6%, p = 0.001) and pneumonia (6.1% vs. 27.3%, p = 0.021). Functional outcomes did not differ between groups. An ROC analysis identified 76 h as the optimal cutoff, supporting the clinical validity of the 72-hour benchmark. Early surgical stabilization within 72 h was associated with fewer perioperative complications, especially pneumonia, in older adults with high-energy thoracolumbar fractures. These findings highlight the value of timely surgical intervention in this vulnerable population.